Finishing the Diarrhea Business PREVENTING MORE THAN ONE MILLION UNNECESSARY DEATHS

Serge Raharison

The 11th Annual Global Health

Mini-University

The Maternal and Child Health

Integrated Program (MCHIP)

USAID Bureau for Global Health’s flagship maternal,

newborn and child health program

Working in well over 30 countries worldwide

MCHIP supports programming and opportunities for

integration in:

‒ Maternal, Newborn and Child Health

‒ Immunization, Family Planning, Malaria, HIV/AIDS

‒ Water/Sanitation, Urban Health, Health Systems

Strengthening

2

May 2004

Key reference

documents

4

The 2nd leading cause of under-5 death

5

Causes of

deaths among

children under

age 5

2008 (percent)

Children are more vulnerable

Life threatening dehydration in children:

− More H2O body-weight proportion

− Higher metabolic rate

− Kidney less able to conserve water

Poor nutritional status and overall health are

additional risk factors

6

7

Under-5 deaths

8

Number of under-five deaths, by country,

2010 (thousands)

Nearly 2/3

deaths

worldwide

occurs in

just 10

countries

Deaths due

to diarrhea

Nearly three

quarters of

child deaths

due to

diarrhea

occur in just

15 countries

9

10

Mortality due to Rotavirus Disease

The boundaries and names shown and the designations

used on this map do not imply the expression of any

opinion whatsoever on the part of the World Health

Organization concerning the legal status of any country,

territory, city or area or of its authorities, or concerning

the delimitation of its frontiers or boundaries. Dotted

lines on maps represent approximate border lines for

which there may not yet be full agreement.

WHO 2009. All rights reserved

100 to 500 deaths per

100,000

50 to 100 deaths per 100,000

10 to 50 deaths per 100,000

< 10 deaths per 100,000

Source: WHO/IVB database, 193 WHO Member States. Data as of July 2009

Date of slide: September 2009

Rate per 100,000

11

The seven-point plan

Treatment package − 1. Fluid replacement to prevent

dehydration

− 2. Zinc treatment.

Prevention package − 3. Rotavirus and measles

vaccinations

− 4. Promotion of early and

exclusive breastfeeding &

vitamin A supplementation.

− 5. Promotion of handwashing

with soap

− 6. Improved water supply

quantity and quality, including

treatment and safe storage of

household water

− 7. Community-wide sanitation

promotion.

Fluid replacement

Low-osmolarity ORS is

more effective at

replacing fluids than the

previous ORS

formulation and

prevents the risk of

hypernatremia

13

New solution: sodium 75 mEq/l, osmolarity to 245 mOsm/l

Original solution: sodium 90 mEq/l, osmolarity of 311 mOsm/l

How about homemade fluid?

“appropriate homemade fluids” are different from a country

to another and are not always clearly defined

14

Zinc Treatment

the duration and

severity of treated

episodes

the incidence of

diarrhea and

pneumonia in the

subsequent 2-3

months

15

Rotavirus vaccine

16

Rotavirus

gastro­enteritis

kills children

when

hospitalization

and intravenous

rehydration are

not readily

available

Nutrition

Promotion of early

and exclusive

breastfeeding and

Vitamin A

supplementation

are proven to

strengthen the

immune system

17

Handwashing with soap

The single-most cost-

effective health

intervention

18

Investment to gain one DALY

associated with diarrheal diseases :

‒$ 3.35 Handwashing with soap

‒$ 11.00 Latrine promotion

‒> $ 200.00 Household water connection

Water supply

In quantity

In quality, including

treatment and safe

storage of

household water

19

Sanitation

Community-wide sanitation

promotion

20

21

Develop enabling policies

22

Develop enabling policies

23

Expand access to proper case

management

Accurate identification

of childhood illnesses

Systematic combined

treatment of all major

illnesses

Appropriate counseling

of caretakers

Quick referral for

severely ill children

24

Integrated Management of Childhood Illnesses (IMCI)

Expand access to proper case

management

Well-trained, supervised

and supported community

health workers (CHWs)

can successfully diagnose

child pneumonia, malaria,

or diarrhea and provide

effective treatment.

25

Integrated Community Case Management (iCCM)

Community mobilization

“Diarrhea, 90 percent of

which is caused by food and

water contaminated by

excrement, kills a child every

fifteen seconds

That's more than AIDS,

malaria, or measles,

combined. Human feces are

an impressive weapon of

mass destruction”

26 http://www.huffingtonpost.com/rose-george/how-

to-save-the-world-wit_b_334223.html

The CLTS example

27

Families and communities

Priority to promotion of breastfeeding,

handwashing, sanitation and treatment of

household water

Working with government to built, operate

and maintain water supply systems

Involve every community member:

adolescents, schoolteachers, religious

leaders and local business people

28

The public sector

Advance comprehensive prevention and

treatment programs at both the national and

local levels

Intersectoral collaboration: health, education,

commerce, water and sanitation, nutrition,

women’s affairs and urban and rural

development

29

The private sector

Promote innovation in the supply and delivery

of key interventions in partnership with public

institutions.

30

Global partnerships and networks

Forge new links across initiatives, leading to

strong and effective advocacy

Reduce the risk of competing priorities

31

32

MDG targets

4A: by 2/3, between 1990

and 2015, the under-5 mortality

rate

7C: 1/2 by 2015, the

proportion of the pop. without

sustainable access to safe

drinking water and basic

sanitation

8E: Provide access to

affordable, essential drugs in

developing countries

33 2015 is tomorrow…

Little progress was made

34

Little progress was made

There are major gaps between policy change

and effective program implementation

Over the past two decades

− Mortality has declined from 5 to 1.5 million in 2004

− Incidence remained stable: ~ 2.5 billion cases/year

35

36

Whose business is this?

37

HEALTH

BU

DG

ET

Where are the resources?

Competing priorities

AIDS

TB

Malaria

Chronic disease

38

Rotavirus

vaccine roll-out

GAVI plans to

immunize 50

million children

against

rotavirus in 40

countries by

2015

39

Is this a matter of an overall

development?

40

Thank you!

www.mchip.net

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